Transient Rotor Activity During Prolonged 3-Dimensional Phase Mapping in Human Persistent Atrial Fibrillation

OBJECTIVES : This study sought to validate a 3-dimensional (3D) phase mapping system and determine the distribution of dominant propagation patterns in persistent atrial fibrillation (AF). BACKGROUND: Currently available systems display phase as simplified 2-dimensional maps. We developed a novel 3D phase mapping system that uses the 3D location of basket catheter electrodes and the patient’s 3D left atrial surface geometry to interpolate phase and create a 3D representation of phase progression. METHODS: Six-min AF recordings from the left atrium were obtained in 14 patients using the Constellation basket catheter and analyzed offline. Exported signals underwent both phase and traditional activation analysis and were then visualized using a novel 3D mapping system. Analysis involved: 1) validation of phase analysis by comparing beat-to-beat AF cycle length calculated using phase inversion with that determined from activation timing in the same 20-s segment; 2) validation of 3D phase by comparing propagation patterns observed using 3D phase with 3D activation in the same 1-min segment; and 3) determining the distribution of dominant propagation patterns in 6-min recordings using 3D phase. RESULTS There was strong agreement of beat-to-beat AF cycle length between activation analysis and phase inversion (R2 ¼ 0.91). There was no significant difference between 3D activation and 3D phase in mean percentage of propagation patterns classified as single wavefronts (p ¼ 0.99), focal activations (p ¼ 0.26), disorganized activity (p ¼ 0.76), or multiple wavefronts (p ¼ 0.70). During prolonged 3D phase, single wavefronts were the most common propagation pattern (50.2%). A total of 34 rotors were seen in 9 of 14 patients. All rotors were transient with mean duration of 1.0 0.6 s. Rotors were only observed in areas of high electrode density where the interelectrode distance was significantly shorter than nonrotor sites (7.4 [interquartile range: 6.3 to 14.6] vs. 15.3 mm [interquartile range: 10.1 to 22.2]; p < 0.001). CONCLUSIONS During prolonged 3D phase mapping, transient rotors were observed in 64% of patients and reformed at the same anatomic location in 44% of patients. The electrode density of the basket catheter may limit the detection of rotors. (J Am Coll Cardiol EP 2018;4:72–83) © 2018 by the American College of Cardiology Foundation.Bhupesh Pathik, Jonathan M. Kalman, Tomos Walters, Pawel Kuklik, Jichao Zhao, Andrew Madry, Sandeep Prabhu, Chrishan Nalliah, Peter Kistler, Geoffrey Le